For the region of Shiselweni, the MSF staff includes one pharmacist, four pharmacy technicians, and 12 pharmacy assistants (six are in school and therefore work in the clinics intermittently).
This means that six of the 22 primary health clinics are staffed by Pharmacy Assistants (PAs). The current PAs are lay people with additional training in pharmacist practices, diseases, and medications. The pharmacy assistants monitor stock (including stock card management), complete many of the medication orders to CMS [Central Medical Stores] (and MSF), dispense medications to patients, provide medication counseling to the patients, and do the majority of the pre-packing of medications. I have found the PAs to be very proud of their work, including the organization of the dispensary and storeroom. The dispensaries of the remaining 16 clinics are staffed by the nurses (in between patients) or orderlies (lay people who help the nurses). As you might imagine, working in the dispensary is not the favorite task for most of that group.
MSF is sponsoring six students (former PAs for MSF) to go to school at Southern Africa Nazarene University (SANU) for two years to earn their Pharmacy Assistant certificate. We are supporting them through maintaining their salary and benefits while paying for tuition, uniforms, books and supplying a small stipend to assist with rent. During their breaks from school they are expected to work in the clinics. Their commitment to MSF is to work as a PA for two years following their graduation. The goal is to have the PA position recognized by the MoH and eventually incorporate these individuals into the MoH staffing of the clinics following certification.
There are four MSF pharmacy technicians that work in the region. All of them are from Zimbabwe and completed their training there. Three of them are responsible for one of the zones (Hlatikhulu, Nhlangano, Matsanjeni) and are responsible for ensuing orders are completed, stock is managed adequately, redistributing medications between clinics, attending clinic meetings and providing training. They spend much of their time training staff on how to order accurately, the importance of managing stock including use of stock cards, and addressing questions from the clinics (and PAs). The fourth technician is responsible for covering the other technicians for holidays, assisting in clinics that need additional support, assisting with the MSF order throughout the process including fulfillment, and assisting the pharmacist.
I am the MSF pharmacist for the region. My main responsibilities are to address the questions that arise from the pharmacy technicians, Coordination Team of the mission (often related to CMS stock availability), liaising with the MoH/CMS including on technical working groups related to medication supply, addressing clinic questions that arise from the physicians, spend time with the PTs and PAs in the clinics, managing staff health supplies, and ensuring training for the pharmacy staff. I’ll talk more about my role in an upcoming post.
Ideally we would have a PA in each clinic supporting all of the aspects of medication management. This is a lofty goal and one that is not necessarily sustainable. I am happy to see that MSF is sponsoring students to become PAs as this long-term investment in these individuals is invaluable. The team works hard and is proud of the work that they do and the people they help!